ROBERT SIEGEL, HOST:
People who abuse opioids are well aware of the risks of fentanyl, a drug that's up to 50 times more powerful than heroin. Fentanyl is approved by the FDA as a painkiller, but the versions often tied to overdose deaths are cooked up overseas and then shipped to the U.S. and mixed with heroin or other drugs. Buyers rarely know what exactly they're getting. So they're adopting new tactics to stay alive, as Martha Bebinger of member station WBUR reports.
MARTHA BEBINGER, BYLINE: At 37, Allyson is having the experience most Americans face much later in life.
ALLYSON: Basically my entire generation is gone in one year - a year and eight months - 30 people.
BEBINGER: What do you think that's about?
ALLYSON: It's the fentanyl. It's definitely the fentanyl.
BEBINGER: Unlike heroin, fentanyl routinely shuts down breathing in seconds.
ALLYSON: It happens so fast, like instantly, as soon as you do the shot.
BEBINGER: Allyson began using heroin 18 years ago in her late teens.
ALLYSON: In the past, it was something that you saw happening.
EDDIE: Yeah, like, the person would start to...
ALLYSON: Like, you could see the person slow down. Their color would start to turn blue, and then they would go out within 10 minutes or so. Now, it's instant.
EDDIE: You'd be having to pick them up and...
BEBINGER: She and her friend Eddie have stopped by the Cambridge Needle Exchange program. We're not using their full names because buying the drugs they're addicted to is a crime. Manager Meghan Hynes says fentanyl has everyone on edge.
MEGHAN HYNES: Recently, we had a guy leave the bathroom, and he just turned blue. I've never seen anyone turn blue that fast, and he just fell down and was out, not breathing.
BEBINGER: Hynes bent over the man to pump his heart, but he had wooden chest, a side effect of fentanyl.
HYNES: Your chest seizes up. You literally have paralysis, and that's obviously really dangerous because if someone needs CPR, you can't do it.
BEBINGER: Hynes revived the man with naloxone, which she urges all clients to carry, and most do. That's one of the smart-use rules Allyson has adopted in this era of fentanyl. Others - stick to a dealer you trust, use with a buddy and do a small test dose before the full shot.
ALLYSON: But it's really hard to tell these days even if you do a tester shot.
BEBINGER: Because grains of fentanyl aren't mixed uniformly in a bag. Recently, Allyson, who's homeless, got high before falling asleep in a friend's tent. The next morning, Allyson used what was left.
ALLYSON: And I actually said to my friend - I said, wow, I can't believe I only saved myself this much. It was a very small amount, like a third of what I did the night before, and I overdosed on it.
BEBINGER: The friend had to use two doses of naloxone to revive Allyson. Fentanyl is becoming more common because it's cheaper to produce than heroin and small, potent amounts can be mailed easily. These days, says Sean, you have to assume all dope is mixed with fentanyl.
SEAN: Most of us know that that's what we're getting. And if you don't believe it, you're living in a fairy tale world.
BEBINGER: Allyson and Eddie try to avoid fentanyl, but they'll take anything to avoid withdrawal.
EDDIE: With vomiting and diarrhea and...
ALLYSON: ...Literally feels like your skin is crawling off. You're sweating profusely. Your nose is running. Your eyes are running. And that's all you can focus on. You can't think.
BEBINGER: Some drug users seek fentanyl's fast, intense high, but Allyson doesn't like it because the high fades more quickly than heroin. That means she has to find more money to buy more dope or take other drugs to try to extend the fentanyl high.
ALLYSON: Which is increasing the overdoses as well because you're getting a fast rush, but it doesn't last, so people are mixing.
BEBINGER: Older drug users say this moment with fentanyl is the worst they've seen. Sixty-eight-year-old Shug twists a towel in his hands.
SHUG: Addicts are dying, like, every day. It's crazy, man. Excuse me. Nobody seems to give a damn
BEBINGER: Shug says he's grateful for this needle exchange, which hasn't lost anyone to an overdose. That's in contrast to the streets outside where the death toll keeps rising. For NPR News, I'm Martha Bebinger in Boston.
SIEGEL: That story is part of a reporting partnership of NPR and Kaiser Health News.
(SOUNDBITE OF TOPS SONG, "SUPERSTITION FUTURE")
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